effectiveness of an educational program regarding the

KUFA JOURNAL FOR NURSING SCIENCES.VOL.10 No. 1 / 2020 DOI:1475746342

1

Effectiveness of an Educational Program regarding the

Knowledge of women about maternal care during the postpartum

period that attending to the primary health care centers at Al-

Amara City / Iraq

فترة خلال الأم رعايت حىل النساء بمعارف يتعلك فيما التعليمي البرنامج فاعليت مدي

العراق/العمارة مدينت في الأوليت الصحيت الرعايت مراكز في يحضرن الاتي النفاسRasha Leteef Neamah*

Ezedeen F. Bahaaldeen**

Iqbal Majeed Abbas*** الخلاصت:

حذ٠ث الا صحت ححض١ الابث ضبعفبث الب٠ت ف حض اخ اصح١ت اشعب٠ت ىبث ا احذ الادة بعذ ب اشعب٠تخلفيت البحث:

الأبث إعذاد عبئلاح لأبث الأصبص اصح اخثم١ف حف١ش ف حخث اعبطف١ت اعم١ت الأبث احخ١بجبث حب١ت إ ببلإضبفت الادة

.الأت ح افعبي خمذ حشج١ع الأ أداس مبي

اشعب٠ت شاوز ف ٠حضش الاح افبس فخشة خلاي الأ سعب٠ت حي اضبء بعبسف ٠خعك ف١ب اخع١ ابشبج فبع١ت ذ ححذ٠ذ الهدف:

. اعشاق/اعبسة ذ٠ت ف الأ١ت اصح١ت

( 68) ( دساصت جعت( )68) الادة خعذدة اشأة (172) حخى غشض١ت احخب١ت غ١ش ع١ت حجش٠ب١ت شب دساصت أجش٠ج المنهجيت:

2016 \حشش٠ الاي \1) اذساصت أجش٠ج. اعبسة ذ٠ت ف الأ١ت اصح١ت شعب٠ت شاوز ثب١ت اخخ١بس ح ، اضببطت جعت

اذ٠غشاف١ت الاجخبع١ت اخصبئص/ الأي اجزء: ره ف بب ، سئ١ض١ت أجزاء ثلاثت الاصخب١ب ٠خى (2020 \ اثب وب \ 22إ

صف الاحصبء ببصخخذا اب١ببث حح١ ح الادة بعذ ب فخشة حجب اضبء عبسف/ اثبث اجزء الإجبب١ت اخصبئص/ اثب اجزء ا

. (وـــــــــب شبع t اخخببس) الاصخذلا الاحصبء( اضب الاوخفبء اذسجبث خصظ الاشىبي اجذاي ائ٠ت اضبت اخىشاساث)

عبسف ف إحصبئ١ت دلات ر فشق بن ا صت≤( 00-18) ب١ اضبء عش خصظ وب اب١ببث حح١ خلاي النتائج: شعب٠ت اضبء

بث امـب ببسالاخخـ ب١ الادة بعذ ب فخشة ف الابث سعب٠ت ف اضبء عبسف حي اخع١ ابشبج حف١ز بعذ لادةا عذبـ ب خشةفـ ف الأ

امـب ببسالاخخ ١بــ لادةا بـعذ ب خشةفـ ف الأـبث تشعب٠ـ ضبءاـ فـعبس ف إحصبئ١ت دلات ر فشق ذ٠جـ لا ساصتاذ جعتـ ابعذ

بث فعبس اعش ب١ ىض١تعـ لالتعـ ـبن وبج طتاضببـ تجعـ عذابـ .اذساصت جـعتـ ابعذ ببسالاخخ ف اىـ١ت الا

امب الاخخببس ب١ الادة بعذ ب فخشة ف الأ بشعب٠ت اى١ت اضبء عبسف ف إحصبئ١ت دلات راث فشق جد إ اذساصت خصج الاستنتاج:

ابعذ امب الاخخببس ب١ الادة بعذ ب فخشة ف اى١ت اضبء عبسف ف إحصبئ١ت دلات ر فشق بن ١ش اذساصت جعت ابعذ

.اضببطت جعت

ب فخشة ع اشأة عشفت خحض١ ص١ت اعخببس ٠ى ح١ث الادة بعذ ب الا عب٠تس ح ج حذس٠ب بشبج خف١زب اذساصت اصج التىصياث:

.لادةا عذب

حع١، حأث١ش، عشفت، فخشة افبس، بشبج، ضبء. الكلماث المفتاحيت:

ABSTRACT:

Background: Postpartum care as one of the most important components of health care contributes to the

prevention of maternal complications and improvement of maternal/neonatal health. In addition to meeting

mothers’ mental and emotional needs consist of providing basic health education to mothers and her families,

preparing mother to accept their maternal roles and encouraging an effective progress to motherhood.

Aim of the Study: To determine the effectiveness of an Educational Program regarding the Knowledge of

women about maternal care during the postpartum period who attending the primary health care centers in the

Amara City / Iraq.

Methodology: Quasi-experimental design was accomplish on non-probability (Purposive sample) used to collect

the data from (172) multigravida women (86) study group and (86) control group who were selected from the

eight primary health care centers. The study was conducted from (1st December, 2018 to 22 January, 2020).The

questionnaire was consisted of three main parts, including: part one/Socio-demographic characteristics, part two/

Reproductive Characteristics, and part three /women's knowledge toward the postpartum period. The analysis of

data was performed through the application of descriptive statistical (frequency, percentage, tables, figures, mean

of score and relative sufficiency) and inferential statistical (t-test and chi-square).

Results: through analysis of data was the age range of the women was between (16-40 ≥ ) years and there was a

statistically significant difference in women’s knowledge for maternal care in the postpartum period between the

pretest and posttest for study group, There is a no statistically significant difference in women’s knowledge for

maternal' care in the postpartum period between the pretest and posttest for the control group, Also there was

statistically significant inverse correlation between women’s age and their overall knowledge in the posttest.

Conclusions: The study was concluded that there was statistically significant difference in women’s overall

knowledge for maternal care the in postpartum period between the pretest and posttest time for study groups, and

there is no statistically significant difference in women’s overall knowledge in the postpartum period between

the pretest and posttest times for the control group.


2

Recommendations: it was recommended that: Implemented training oriented program about postpartum care

and can be considered as a means for the improvement of women's knowledge about the postpartum period.

Key words: Education, Effectiveness, Knowledge, Postpartum Period, Program, Women.

____________________________________________________________________________________

* PhD Student, academic Nursing Specialist, High Institute of Health Vocational, Ministry of Health.

E-mail: [email protected].

** PhD. Prof. and Academic Supervisor, Department of Maternal and Neonatal Nursing, College of Nursing.

E-mail: ezedeengo@ yahoo.com.

*** PhD. Emeritus Prof. and Academic Supervisor, Department of maternal and neonatal nursing, Baghdad

College of Medical Sciences. E-mail: [email protected].

INTRODUCTION: Postpartum period, defined by the World Health Organization (WHO) as the period

from childbirth to the 42nd day following delivery, is critical for both mothers and new-born.

An estimated 529,000 maternal deaths occur worldwide each year because of pregnancy-

related complications in the ante-natal, intrapartum, and postpartum periods, especially in

resource-limited settings. These deaths are often sudden and unpredictable, with 11% to 17%

occurring during childbirth itself and 50% to 71% occurring during the postpartum period (1)

.

The purpose of postpartum care is the prevention and early diagnosis of complications

in this period, mothers’ quick return to a normal status, encouraging breastfeeding and

providing family planning services to improve the physical health of mothers and infants. In

addition, meeting mothers’ mental and emotional needs comprises of providing basic health

education for mothers or families, preparing women to accept their maternal roles and

facilitating a successful transition to parenthood (2)

.

Postnatal mothers had inadequate knowledge of pregnancy, childbirth, postpartum and

newborn care. Therefore, educational intervention at multiple levels is required during the

period of antenatal and postnatal visits (3)

. Postnatal care is another critical intervention for

tackling most causes of maternal and child mortality. Postnatal care helps to detect and

manage complications that may arise at the time of labor, delivery, or early after delivery. The

postnatal period is the time to counsel the mother about maternal nutrition, breastfeeding, and

other childcare practices. During ANC, health workers can inform mothers about neonatal and

maternal danger signs that may occur during the postnatal period. In addition, emotional and

psychosocial support is provided to alleviate stress (4)

. The postpartum period lasts for

approximately 6–8-weeks, starting from childbirth and ending with the restoration of the

reproductive organs and other body systems to their pre-pregnancy state. In this period,

significant physiological, social, and emotional changes occur in the woman (5)

.

Post -partum period has been termed the fourth stage of labor and has three distinct but

continuous phases; Phase one is the initial or acute period and involves the first 6-12 hours

postpartum. This is a time of rapid change with a potential for immediate crises such as

postpartum hemorrhage, uterine inversion, amniotic fluid embolism, and eclampsia (6)

.

Hypothesis:

1. H1: Women who are attended an education program about postpartum care have higher level

of knowledge than women who are not.

2. H2: There are an inverse relationship between age and women's knowledge.

AIM OF THE STUDY To determine the effectiveness of an Educational Program regarding the Knowledge of

women about maternal care during the postpartum period who attending the primary health

care centers in the Amara City / Iraq.

mailto:[email protected]

mailto:[email protected]


3

METHODOLOGY: Quasi-experimental design is accomplish on non-probability (Purposive sample) to

determine the effectiveness of an Educational Program regarding the knowledge of women

about maternal care during the postpartum period who attending the primary health care

centers in the city of Amara / Iraq , the collected data from 172 multigravida women, (86 )

study group and( 86 ) control group who were selected from the eight primary health care

centers (AL-Uroba Primary Health Care Center, AL Zahraa Primary Health Care Center ,AL

Hasen AL-Askerry Primary Health Care Center , AL-Qudis primary health care center, AL-

Ameer primary health care center, AL-Jawideen primary health care center, AL- Amam AL-

Husan. Primary health care center and Ali AL-Ridha Primary Health Care Center, These

centers are choose randomly from 16 primary health care centers in the first sector. The study

was conducted between 1\ December\ 2018 to 22\ January\ 2020. The questionnaire was

consisted of three main parts, including: part one socio-demographic characteristics, part two/

Reproductive Characteristics, and part three/ women's knowledge toward the postpartum

period this part was consisted of 52 items regarding knowledge of women toward postpartum

period, which consisted of three domains first domain women's knowledge toward postpartum

period, this domain was consisted of (25 ) items.

Second domain women's knowledge toward breastfeeding during the postpartum period,

this domain was consisted of 17 items. Third domain women's knowledge toward family

planning, this domain was consisted of 10 items, the content validity of questionnaires was

determined through 12 panels of experts from different health fields. Reliability of the

questionnaire was determined through an application of spilt-half and computation of

Cronbach's Alpha Correlation coefficients (r=0.98). The analysis of data was used the

statistical package for social sciences (SPSS) version 24which, performed through the

application of descriptive statistics (frequency, percentage, tables, figures, means of score and

relative sufficiency) and inferential statistical (t-test and chi-square).

RESULTS: Table (1): Distribution of Study Sample (Study and Control Group) according to Socio-

Demographic characteristics

Variables Study Group (n = 86) Control Group (n= 86) D.F P value Sig

F % F %

Age (Years) 16-23

24-31

32-39

40 and above

19

42

15

10

22.1

48.8

17.5

11.6

27

39

11

9

31.4

45.3

12.8

10.5

3

0.250

NS

Mean (SD) 28.01±6.9 27.20±6.8

Wife's level of education Unable to read and write

Read and write

Primary school graduate

Intermediate school graduate

Secondary school graduate

Diploma

Bachelor's degree and above

4

6

22

15

17

11

11

4.6

7.0

25.6

17.4

19.8

12.8

12.8

7

6

28

17

9

6

13

8.1

7.0

32.5

19.8

10.5

7.0

15.1

6

0.210

NS

Wife's occupation Works

Does not work

13

73

15.1

84.9

6

80

7.0

93.0

1

0.071

NS

Residency Urban

Rural

80

6

93.0

7.0

77

9

89.5

10.5

1

0.339

NS


4

Family type Nuclear

Extended

43

43

50.0

50.0

42

44

48.8

51.2

1

0.893

NS

n=Number of Sample, F. =Frequencies, % Percentage, SD=Standard Deviation, χ2=Chi Square, DF=degree of

freedom, C.S=Comparison Significant, NS=Non Significant at p-value p < 0.05.

Table (1) showed that mean was28.01 ± 6.9; 42(48.8%), in the age group 24-31 years

followed by those who age 16-23-years 19 (22.1%), those who age 32-38-years 15(17.5%),

and those who age 39-46 years 10(11.6%). For the control group the age mean was 27.20 ±.

concerning the wives’ level of education, are primary school graduates 22 (25.6%), followed

by those who are secondary school graduates 17(19.8%), those who are intermediate school

graduates 15(17.4%), those who are each holding a diploma degree and bachelor’s degree and

above 11(12.8%) for each of them, those who read and write 6(7.0%), and those who are

unable to read and write 4 (4.6%). For the control group, are primary school graduates

28(32.5%), followed by those who are intermediate school graduates 17(19.8%), those who

hold a bachelor’s degree and above 13(15.1%), those who are secondary school graduates 9

(10.5%), those who are unable to read and write 7(8.1%), and those who read and write and

those who hold a diploma degree 6(7.0%) for each of them.

Concerning residency, the majority in the study group lives in urban areas 80(93.0%)

compared to those who lives in rural areas 6(7.0%). For the control group, the majority live in

urban areas 77 (89.5%) compared to those who lives in rural areas 9(10.5%).Regarding family

type, women in the study group reported that they live equally of nuclear and extended

families 43( 50.0%) for each type. For the control group, more than a half live in extended

families 44(51.2%0 compared to those who lives in nuclear families 42(48.8%). There were

no a statistical significant difference between study and control group and socio-demographic

characteristics (age, level of education, occupation, residency and family type. 6.8;were age

24-31 years 39( 45.3%), followed by those who age 16-23 years 27( 31.4%), those who age

32-38 years 11(12.8%), and those who age 39-46 years 9( 10.5%).

Table (2): Distribution of Study Sample (Study and Control Group) according to

Reproductive Characteristics Variables Study Group (n = 86) Control (n = 86) D.F P value Sign

F % F %

Gravidity

2

3

4

5-6

7-8

≥ 9

18

19

13

19

11

6

20.9

22.1

15.1

22.1

12.8

7.0

21

23

9

21

7

5

24.4

26.8

10.5

24.4

8.1

5.8

7

0.290

NS

Parity

1

2

3

4

5-6

≥ 7

13

18

22

9

18

6

15.1

20.9

25.6

10.5

20.9

7.0

18

26

9

17

10

6

20.9

30.2

10.5

19.8

11.6

7.0

5

0.233

NS

Abortion

None

1

2

3-4

64

12

8

2

74.4

14.0

9.3

2.3

62

13

9

2

72.1

15.1

10.5

2.3

3

0.665

NS

Stillbirth

None

1

2

70

6

6

81.4

7.0

7.0

72

10

3

83.7

11.6

3.5

3

0.071

NS


5

≥ 3 4 4.6 1 1.2

Number of Live Children

None

1

2

3

4

5-6

≥ 7

3

14

16

24

13

12

4

3.5

16.3

18.6

27.9

15.1

14.0

4.6

2

18

28

11

13

10

4

2.3

20.9

32.6

12.8

15.1

11.6

4.6

6

0.207

NS

n=Number of Sample, F. =Frequencies, % Percentage, SD=Standard Deviation, χ2=Chi Square, DF=degree of

freedom, C.S=Comparison Significant, NS=Non Significant at p-value p < 0.05.

Table (2) showed that the number of gravidity in the study group 19 (22.1%) have

three and five-six pregnancy, 19 (22.1%). while the control group showed that they have three

pregnancies 23 ( 26.8% .( Regarding parity, the parity in the study group have three deliveries

22 ( 25.6%) ,while the control group, concerning the parity have two deliveries 26 ( 30.2%).

With respect to abortion, the majority in the study group reported that they do not have

abortion 64 (74.4%) while the control group, they do not have abortion 62 (72.1). Concerning

stillbirth, the majority in the study group they do not have stillbirth 70 (81.4%), while the

control group, they do not have stillbirth 72 (83.7). Regarding the number of live children, in

the study group they have three live children 24 (27.9), while the control group they have two

live children 28 (32.6).

Figure (1): Complications of pureperuim among Study Group

Figure (1) showed that around a quarter of women in the study group reported that they

experienced vaginal bleeding 22 (25.6%). followed by hypertension 15 (17.4%), postpartum

depression 14 (16.3%), hemorrhoids 12 (14.0%), puerperal fever 11 (12.8%), and uterine

inversion 6 (7.0%).

Figure (2): Bar chart Complications of Pureperuim among Control Group

Figure (2) showed that less than a fifth reported that they experienced vaginal bleeding

13 (15.1%) followed by each of hemorrhoids and postpartum depression 9 (10.5%) for each

of them, hypertension 4 (4.7%) puerperal fever 3 (3.5%) and uterine inversion (0.0%).

0102030

Vaginalbleedin

gHemorr

hoids

Postpartumdepre…

Puerperal fever

Uterineinversio

n

Hypertension

Series1 25.6 14 16.3 12.8 7 17.4

25.6 14 16.3 12.8 7 17.4

Pe

rce

nta

ges

Complications of Pureperuim

05

101520

15.1 10.5 10.5 3.5 0 4.7

Pe

rce

nta

ges

Complications of Pureperuim


6

Table (3): Differences in women’s knowledge about pureperuim between pretest and posttest

for the study group

Li

st. Item Resp.

Pretest - Study G. (n= 86) Posttest - Study G. (n= 86)

t

P-

valu

e

CS F % MS

R.S

% Ass. F % MS

R.S

% Ass.

1.

Concept of

Postpartum

period

Incor. 78 90.7

1.09 54.5 L

1 98.8

1.98 98.5 H -

25.417 .000 S

Corr. 8 9.3 85 1.2

2.

Duration of Postpartum

period

Incor. 80 93.0 1.06 53.0 L

2 95.3 1.97 99.0 H

-

30.972

.000 S Corr. 6 7.0 84 4.7

3.

The stage of

Postpartum

period

Incor. 80 93.0 1.06 53.0 L

2 2.3 1.97 98.5 H

-

25.489 .000 S

Corr. 6 7.0 84 97.7

4.

Complications during

first stage

of post-partum

period

(pureperuim)

Incor. 84 97.7

1.02 51.0 L

4 4.7

1.95 97.5 H -

33.665 .000 S

Corr. 2 2.3 82 95.3

5.

Complicati

ons during second

stage of

postpartum period

Incor. 78 90.7

1.09 54.5 L

1 98.8

1.98 99.0 H -

24.137 .000 S

Corr. 8 9.3 85 1.2

6. Meaning of

Lochia

Incor. 85 98.8

1.01 50.5 L

0 0.0

2.00 100.

0 H

-41.743

.000 S

Corr. 1 1.2 86 100.

0

7. Sexual

intercourse

Incor. 84 95.3

1.04 52.0 L

0 0.0

2.00 100.

0 H

-

41.743 .000 S

Corr. 2 4.7 86 100.

0

8. Divided of

Lochia

Incor. 85 95.3 1.01 50.5 L

3 3.5 1.96 98.0 H

-41.743

.000 S Corr. 1 4.7 83 95.5

9.

Critical

period of a

mother's life is

Incor. 84 95.3 1.04 52.0 L

1 98.8 1.98 99.0 H

-

37.108 .000 S

Corr. 2 4.7 85 1.2

10.

Duration of

uterus return to

the normal

status after delivery

during

Incor. 84 95.3

1.04 52.0 L

1 98.8

1.98 99.0 H -

37.108 .000 S

Corr. 2 4.7 85 1.2

11.

Weight of

uterus through 42

days

Incor. 80 93.0

1.06 53.0 L

2 95.3

1.97 98.5 H -

28.788 .000 S

Corr. 6 7.0 84 4.7

12.

Main complicatio

ns during

postpartum period

Incor. 84 95.3

1.02 51.0 L

3 3.5

1.96 98.0 H -

37.108 .000 S

Corr. 2 4.7 83 95.5

13.

Warning

signs for

the mother

during

(pureperuim) include

Incor. 80 93.0

1.06 53.0 L

0 0.0

2.00 100.

0 H

-

33.665 .000 S

Corr. 6 7.0 86 100.

0

14.

After pain

which

occurs after birth is due

to

Incor. 84 95.3

1.02 51.0 L

1 98.8

1.98 99.0 H -

48.494 .000 S

Corr. 2 4.7 85 1.2


7

15.

Postpartum

blues may

occur

Incor. 84 95.3

1.04 52.0 L

0 0.0

2.00 100.

0 H

-

41.743 .000 S

Corr. 2 4.7 86 100.

0

16.

Signs and

symptoms of

postpartum

blues after delivery

Incor. 84 95.3

1.04 52.0 L

4 4.7

1.95 97.5 H -

25.489 .000 S

Corr. 2 4.7 82 95.3

17.

Postpartum

blues may disappear

after

Incor. 81 94.2

1.05 52.5 L

0 0.0

2.00 100.

0 H

-37.108

.000 S

Corr. 5 5.8 86 100.

0

18.

Common causes of

Puerperal

sepsis

Incor. 82 95.3

1.04 52.0 L

4 4.7

1.95 97.5 H -

25.489 .000 S

Corr. 4 4.7 82 95.3

19.

Signs and symptoms

of

Puerperal sepsis

Incor. 83 95.5

1.03 51.5 L

4 4.7

1.95 97.5 H -

30.972 .000 S

Corr. 3 3.5 82 95.3

20.

Signs and

symptoms of

Postpartum

hypertension

Incor. 83 95.5

1.03 51.5 L

4 4.7

1.95 97.5 H -

27.050 .000 S

Corr. 3 3.5 82 95.3

21.

Signs and

symptoms of deep

venous

thrombosis (DVT)

Incor. 84 95.3

1.02 51.0 L

2 95.3

1.97 98.5 H -

41.743 .000 S

Corr. 2 4.7 84 4.7

22.

Prevention

of deep

venous thrombosis

Incor. 85 95.3 1.01 50.5 L

3 3.5 1.95 97.5 H

-

41.743 .000 S

Corr. 1 4.7 83 95.5

23.

Postpartum

hemorrhage means

Incor. 85 95.3 1.01 50.5 L

4 4.7 1.95 97.5 H

-

37.108 .000 S

Corr. 1 4.7 82 95.3

24.

Causes of Postpartum

hemorrhage

Incor. 83 95.5

1.03 51.5 L

0 0.0

2.00 100.

0 H

-

48.494 .000 S

Corr. 3 3.5 86 100.

0

25.

Preventive

factors of

postpartum hemorrhage

Prevention

of deep venous

thrombosis

Incor. 84 95.3

1.02

51.0

L

0 0.0

2.00 100.

0 H

-

59.749 .000 S

Incor. 85 95.3 3 3.5

Ass.= Assessment, C.S. = Comparative Significance, Corr. = Correct, , f = Frequency, H = High (R.S = 87.6% –

100%), M = Moderate (R.S = 75 % - 87.5%), L = Low (R.S = less than 75%), MS = Mean Score, , n= Number

of sample, R.S = Relative Sufficiency, Resp. = Response, % = Percentage, t = t-test, S = Significant at P- value

≤ 0.05.

Table (3) reveals that all items of women’s knowledge about pureperuim are of low

mean scores with low Relative Sufficiency (R.S) and their assessment is low in the pretest

time. In the posttest time, all items are of high mean scores with high R.S. and their

assessment is high with statistically significant differences in all items.

Table (4): Differences in women’s knowledge about breastfeeding during pureperuim

between pretest and posttest for the study group

Li

st Item Resp


t P-

value CS

f % MS R.S

% Ass. F % MS

R.S

% Ass.


8

1.

What do

you give to

the

newborn

after delivery

Incor 84 95.

3 1.02 51.0 L

0 0.0

2.00 100.

0 H

-

59.749 .000 S

Corr. 2 4.7 86 100.

0

2.

Benefits of

breastfeedi

ng for the mother

Incor 84 95.

3 1.02 51.0 L

7 8.1 1.91 95.5 H

-

24.137 .000 S

Corr. 2 4.7 79 91.9

3.

When

colostrum

secretion started

Incor 84 95.

3 1.02 51.0 L

0 0.0

2.00 100.

0 H

-

59.749 .000 S

Corr. 2 4.7 86 100.

0

4.

Benefits

Breastfeeding for

newborn

Incor 86 100

.0 1.00 50.0 L

0 0.0

2.00 100.

0 H

-48.494

.000 S

Corr. 0 0.0 86 100.

0

5.

The

duration of breastfeedi

ng:

Incor 83 96.

5 1.03 51.5 L

5 5.8

1.94 97.0 H -

30.972 .000 S

Corr. 3 3.5 81 94.2

6.

Women

non breast feeding the

ovulation and

menstrual

cycle return

through

Incor 85 98.8

1.01 50.5 L

2 95.3

1.97 98.5 H -

48.494 .000 S

Corr. 1 1.2 84 4.7

7.

What is

exclusive breastfeedi

ng

Incor 84 95.

3 1.02 51.0 L

2 95.3

1.97 98.5 H -

41.743 .000 S

Corr. 2 4.7 84 4.7

8.

Exclusive breastfeedi

ng may

prevent pregnancy

if mother

feeding a baby for

Incor 84 95.

3

1.02 51.0 L

3 3.5

1.96 98.0 H -

37.108 .000 S

Corr. 2 4.7 83 95.5

9.

Signs and

symptom

that indicate the

baby is

hungry

Incor 84 95.

3

1.02 52.0 L

0 0.0

2.00 100.

0 H

-

59.749

.000 S

Corr. 2 4.7 86 100.

0

10.

Good signs

of

attachment of baby

during

breastfeeding are

Incor 84 95.

3

1.02 51.0 L

0 0.0

2.00 100.

0 H

-

59.749 .000 S

Corr. 2 4.7 86 100.

0

11.

The period

of breastfeedi

ng that

compensates for water

Incor 85 98.

8

1.05 52.5 L

0 0.0

2.00 100.

0 H

-

37.108 .000 S

Corr. 1 1.2 86 100.

0

12.

Position of

breastfeedi

ng

Incor 86 100

.0 1.00 50.0 L 2 95.3

1.97 98.5 H -

59.749 .000 S

Corr. 0 0.0 84 4.7

13.

What is breast

engorgeme

nt

Incor 86 100.0

1.00 50.0 L

2 95.3

1.97 98.5 H -

59.749 .000 S

Corr. 0 0.0 84 4.7

14.

Causes of

breast engorgeme

nt

Incor 84 95.3

1.02 51.0 L

0 0.0

2.00 100.

0 H

-59.749

.000 S

Corr. 2 4.7 86 100.

0

15. Treatment Incor 86 100 1.00 50.0 L 1 1.2 1.98 99.0 H - .000 S


9

of breast

engorgeme

nt

.0 85.000

Corr. 0 0.0 85 98.8

16.

Causes of nipple

cracking

Incor 85 98.

8 1.01 50.5 L

0 0.0

2.00 100.

0 H

-

37.836 .000 S

Corr. 1 1.2 86 100.

0

17.

Treatment of nipple

cracking

Incor 85 98.

8 1.01 50.5 L

0 0.0

2.00 100.

0 H

-

85.000 .000 S

Corr. 1 1.2 86 100.

0


100%), L = Low (R.S = less than 75%), M = Moderate (R.S = 75 % - 87.5%), MS = Mean Score, , n= Number


≤ 0.05.

Table (4) demonstrates that all items of women’s knowledge about breastfeeding during

pureperuim are of low mean scores with low R.S. and their assessment is low in the pretest

time. In the post test time, all items are of high mean scores with high R.S. and their

assessment is high with statistically significant differences in all items.

Table (5): Differences in women’s knowledge about family planning between pretest and

posttest for the study group

Li

st Item

Resp

.


t P-

value CS

F % MS R.S

% Ass. F % MS

R.S

% Ass.

1.

How long is the

appropriate

pregnancy interval after

normal

delivery

Incor 83 96.5

1.03 51.5 L

5 5.8

1.94 97.

0 H -25.489 .000 S

Corr. 3 3.5 81 94.2

2.

How long is

the

appropriate pregnancy

interval after

cesarean section

Incor 83 96.5

1.03 51.5 L

5 5.8

2.00 100

.0 H -48.494 .000 S

Corr. 3 3.5 81 94.2

3.

Duration of

using family planning

methods for

non-nursing mother after

birth

Incor 85 98.8

1.01 50.5 L

4 4.7

1.95 97.5

H -37.108 .000 S

Corr. 1 1.2 82 95.3

4.

When an

intrauterine device should

be used

Incor 83 96.5

1.03 50.0 L

0 0.0

2.00 100.0

H -48.494 .000 S

Corr. 3 3.5 86 100.

0

5.

What are contraception

methods

Incor 84 95.3

1.02 51.0 L

0 0.0

2.00 100

.0 H -59.749 .000 S

Corr. 2 4.7 86 100.

0

6.

Benefits using of the

contraceptive

pills

Incor 84 95.3

1.02 51.0 L

0 0.0

2.00 100

.5 H -59.749 .000 S

Corr. 2 4.7 86 100.

0

7.

Benefits using of

contraceptive

s pills in other aspects other

than contraception

Incor 86 100.0

1.00 50.0 L

2 95.3

1.97 98.

5 H -59.749 .000 S

Corr. 0 0.0 84 4.7

8. When a woman

Incor 86 100.0 1.00 50.0 L 3 3.5 1.96 98.0

H -48.494 .000 S


11

cannot take

birth control

pills

Corr. 0 0.0 83 95.5

9.

The easies

contraceptive method is

Incor 84 95.3

1.02 50.5 L

0 0.0

2.00 100

.0 H -59.749 .000 S

Corr. 2 4.7 86 100.

0

10.

What is the most effective

contraceptive

methods

Incor 86 100.0

1.00 50.0 L

3 3.5

1.96 98.

0 H -48.494 .000 S

Corr. 0 0.0 83 95.5


100%), L = Low (R.S = less than 75%), M = Moderate (R.S = 75 % - 87.5%), MS = Mean Score, , n= Number


≤ 0.05.

Table (5) reveals that all items of women’s knowledge family planning are of low mean

scores with low R.S. and their assessment is low in the pretest time. At the post test time, all

items are of high mean scores with high R.S. and their assessment is high with statistically

significant differences in all items.

Table (6): Difference in women’s overall knowledge about pureperuim between the pretest

and posttest for study and control groups Paired Samples Test

Overall Knowledge

Paired Differences

T DF Sig. (2-

tailed) Mean

Std.

Deviation

Std. Error

Mean

95% Confidence Interval

of the Difference

Lower Upper

Study Pretest – Study

posttest 49.418 6.65 0.717 47.991 50.845 68.861 85 0.000

Control Pretest –

Control Posttest 1.139 7.428 0.801 0-.453 2.732 1.423 85 0.159

SD=Standard Deviation, Std. Error=Standard Error, DF=degree of freedom, Sig=Significant, =Mean, T=T-test.

Table (6) showed that there is a statistically significant difference in women’s overall

knowledge about pureperuim between the pretest and posttest for study group (p-value =

.000). For the control group, there is no statistically significant difference in women’s overall

knowledge about pureperuim between the pretest and posttest times by using t-test.

DISCUSSION - Discussion of the Socio- demographic Characteristics of the Women

Age

Throughout the data analysis the finding of the study sample indicated that nearly half

of women were 42(48.8%) within the age group (24-31) years, and less than a half age 24-31-

years (n = 39(45.3%) for the control group. This result reveals a fact that this age group of

the women married in adult age and increase awareness to the reproductive health and

dangers of adolescence married. This finding was supported by Al-Mutairi and Al-Omran

(2017) conducted on thirty women in seven PHCs Ministry of health (MOH), Riyadh city, to

assess the knowledge and practice of breast feeding, the majority of women were within the

average age of their study sample were 25–35 years of age (49%) (7)

.

Level of Education

Concerning women's level of education, around a quarter in the study group are primary

school graduates 22( 25.6%), and less than a third 28 (32.5%) for the control group are


11

primary school graduates, This result reveals that the education in past years at AL-Amara

City was not supported and not encouraged especially for women to continue their education.

So most women did not have the opportunity to continue their education because of social and

cultural nature (sex discrimination) and being married an opportunity age, particularly those

who are living in the rural area who are mostly involved in either farming or early marriage.

This finding was supported by AL-Abedi and Al-Asadi (2016) on 150 lactating mother

assessment of mother's knowledge toward breastfeeding at AL-Najaf City, they showed that

the majority of mothers (28.7%) graduated from primary school (8)

. Also this result agree with

Gupta et al., (2018) study on 414 both preterm and term babies who were born at Chhattisgarh

in India, they reported that 104 (25.1) had Primary school (9)

.

Women's occupation

The major group of the study sample in study group in regarding to their occupational

status were housewives 73 (84.9%) compared to those who work 13(15.1%). For the control

group, the majority were housewives 80 (93.0%) compared to those who work 6 (7.0%). This

finding was supported by Khodabandeh et al., (2017) conducted on 220 mothers admitted to

postpartum units of two teaching hospitals affiliated with Tabriz University of Medical

Sciences (Al-Zahra and Taleghani, The majority of mothers in the intervention group (90.2%)

and control group (92.6%) were housewives (10)

. Also this result agree with study done by

Abd El-Razek., (2013) on 200 mother in a Middle Eastern city of El-Basher Hospital,

Amman, Jordon, which showed that The majority of mothers were housewives

(83.5%).Concerning present study in both groups, the majority were did not have any

academic certification or less to give them a chance of working at ALaara city in addition to

early marriage (11)

.

Residency

In regard to the subjects residency the highest percentages (93.0 %.), (89.5%)

respectively for both study and control groups were living in urban area, while 6 (7.0%),

(10.5%) respectively for both study and control group, were live in rural areas. This finding

agreed with Berhea et al., (2018) study on 456 postpartum mothers in Mekelle City, North

Ethiopia showed that the majority of women were (89.6%) were living in urban area. This

result indicated that the target sample of the research was taken from the city centres of Al-

Amara City (12)

.

Type of Family

Regarding family type, women in the study group reported that they live equally of

nuclear and extended families 43 (50.0%) for each type. For the control group, more than a

half live in extended families 44 (51.2%) compared to those who live in nuclear families 42

(48.8%).this finding agree with Missiriya, (2016) study 60 postnatal mothers to assess their

knowledge and practice in Thandalam, India were most study sample living in Nuclear family

(52%). These results indicated to that most families in Maysan begin increased and this result

made the family to be living in another place (6)

.

- Distribution of the Study Sample by their Reproductive Characteristics

Gravidity and Parity

shows that more than a fifth had 5-6 pregnancies 19 (22.1%) for study group while more

than a quarter have the same pregnancies 23(26.8%) for the control group, and Regarding

parity around a quarter have three deliveries (n = 22; 25.6%). for study group and for the

control group less than a third have two deliveries (n = 26; 30.2%), These finding indicated

that most of the study sample were "grandmulti gravida & para". The study concluded that the

study sample may had no awareness for using family planning ,or the desire and attitude of

the couples to have big family related to the social norms and culture perspectives of the area

in Governorate of Maysan. Shahid and Moshtaq (2009) who reported in their study that


12

maternal complications increased with the increased of parity, so the grand multipara still as

high risk pregnancy .In addition the risk of having suboptimal pregnancy outcomes increase

in women who are experiencing their sixth or higher birth (13)

.

Number of Abortion and Stillbirth

The same table showed that three quarter of women in the study group reported that

they do not have abortion 64 (74.4%), and 62 (72.1%), for the control group , Concerning

stillbirth, the majority in the both groups study and control group reported that they do not

have any stillbirth 70 ( 81.4%),72 ( 83.7%). This result agrees with Masoud and Saber (2016)

who conducted on (100) primiparous and multiparous, at the Beni Suef general hospital in

Egypt they showed that most of women had not abortion (70.0%), and majority of the women

did not had still birth (94.0%) (14)

.This results indicated that most study sample in both group

had good health status and absent from obstetrical problem and healthy diet and most of them

were didn’t work this effect on their live style which include psychological status and

comfort.

Number of Live Children

Regarding the number of live children, more than a quarter reported that they have three

live children 24 (27.9%), for study group, and for the control group, less than a third reported

that they have three live children 28 (32.6%). This result agrees with Masoud and Saber

(2016) who was conducted in (100) primiparous and multiparous, at the Beni Suef general

hospital in Egyptian. They showed that shows that; nearly more than a quarter of the sample

of pregnant women had three live children (26%) (14)

.

Complications during Pureperuim

Regarding the complications during pureperuim the result indicated that the study group

reported that they had vaginal bleeding were 22 (25.6%), followed by hypertension 15

(17.4%), postpartum depression 14 (16.3%), hemorrhoids 12 (14.0%), puerperal fever 11

(12.8%), and uterine inversion 6 (7.0%). And regarding to the control group reported that had

vaginal bleeding 13 ( 15.1%) followed hemorrhoids and postpartum depression 9 ( 10.5%), 9

(10.5%) respectively, hypertension 4 (4.7%), and puerperal fever 3( 3.5%) this result was

agreed with Sharma e t al.,(2018), who reported that 150 randomly selected pregnant showed

that women's complications during pureperuim were puerperal sepsis in 12%. This result

indicated that quarter of women suffered from postpartum hemorrhage and the other

complications were less incidence which distributed between Hemorrhoids, Uterine inversion,

Postpartum depression, Puerperal fever and Hypertension, this meaning that some women

after birth not comment by stay in hospital at least two hour in fourth stage of labor which

lead to occur postpartum hemorrhage (5)

.

- Discussion of the Distribution of the women’s knowledge about pureperuim between

pretest and posttest for the study group

Analysis of data concerning women’s knowledge about pureperuim reveals that all

items of women’s knowledge about pureperuim is low in the pretest time and In the posttest

time, all items are of high mean scores with high R.S. and their assessment is high with

statistically significant differences in all items by using t-test. This result agrees with study

done by Indu (2016) on 35 mothers in hospital in India showed that there was a significant

difference on knowledge regarding postnatal diet before and after educational education (15)

.


13

- Distribution of the Women’s Knowledge about breastfeeding during pureperuim

between Pretest and Posttest for the Study Group

Analysis of data concerning women’s knowledge about pureperuim reveals that tall

items of women’s knowledge about breastfeeding during pureperuim are of low mean scores

with low R.S. and their assessment is low in the pretest time. This result was disagreed with

the study was done by AL-Abedi and Al-Asadi (2016) on150 lactating mothers in six primary

health care centers at AL-Najaf city, showed that the majority of mother's responses to the

knowledge items about breastfeeding are good. And in the posttest time, all items are of high

mean scores with high R.S. and their assessment is high with statistically significant

differences in all items by using t-test (8)

.

- Discussion of the Distribution of the Women’s Knowledge about Family Planning

between Pretest and Posttest for the Study Group

Analysis of data concerning women’s knowledge about family planning reveals that that

all items of women’s knowledge about family planning women’s knowledge family planning

are low in the pretest time and their assessment is high with statistically significant

differences in all items in posttest. This result agree with study done by Abdulrazaq et al

(2014) on 963 married women in in Nigeria, where the knowledge score in the intervention

group toward family planning increased significantly while there was no change in the control

group (16)

.

- Discussion of women’s overall knowledge about pureperuim between the pretest and

posttest for study and control group

Analysis of data about women’s overall knowledge about pureperuim between the

pretest and posttest for study and control groups shows that there were a statistically

significant difference in women’s overall knowledge about pureperuim between the pretest

and posttest for study group (p-value = .000) while there is no statistically significant

difference in women’s overall knowledge about pureperuim between the pretest and posttest

times. For the control group, this result was agreed with study was done by Shrestha et al

(2016) on intervention (74) and (69) control group, they showed that the intervention group

had significantly increased maternal newborn care knowledge and confidence (16)

. Also this

result agree with study was done by Mokhtari, et al (2018) On 62 mothers at the postpartum;

showed that after the intervention, knowledge about mother's health was significantly higher

in the intervention group who received postpartum home care compared with the control

group who received the routine postpartum care (p = 0.001).This result indicated that most

women had a desire and ability to learn and acquire knowledge and practices of the

postpartum period, especially postpartum women in AL-Amara City (17)

.

CONCLUSIONS

The study was concluded that there was statistically significant difference in women’s

overall knowledge for maternal care in postpartum period between the pretest and posttest

times, and there is no statistically significant difference in women’s overall knowledge in

postpartum period between the pretest and posttest times for the control group.


14

RECOMMENDATIONS: The study was recommended:

1. The finding of the study indicated that all health team members should be aware of the need

of observing, supervising, teaching and improving the postpartum care.

2. Training oriented program about postpartum period and can be considered as a means for the

improvement of women's knowledge and practice about postpartum period.

3. Health education can be imparted through mass media that is through radio, television,

documentary films, booklet, posters and adapting educational programs through mass media

mainly television, which aim at raising awareness toward postpartum period and promote the

healthy practices.

REFERENCES: 1. Yonemoto, N., Dowswell, T., Nagai, S., & Mori, R. Schedules for home visits in the early

postpartum period. Evidence‐based child health: a Cochrane review journal.2017; 9(1):5-99. 2. Mirzaee, K., & Taghi Shakeri, M. Maternal knowledge on postpartum care in healthcare

centers of Mashhad, Iran in 2013. Journal of Midwifery and Reproductive Health. (2015);

3(4): 456-464. 3. Behal, M., Vinayak, R., & Kumar, A. Assessment of mother's knowledge towards pregnancy,

childbirth, postpartum and essential newborn care in district Solan, HP. International Journal

of Community Medicine And Public Health.2018; 5(5): 2129-213721.

4. Fekadu, G. A., Ambaw, F., & Kidanie, S. A. Facility delivery and postnatal care services use

among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of

the 2016 demographic and health survey. BMC pregnancy and childbirth, 2018; No. 137.

5. Sharma.S.,S., Bhattacharjee.S., Kashyap.A, Thakur.A, Dubey.S .Medical complications of

puerperium: a single center observational study: International Journal of Advances in

Medicine . Jun 2018; 5(3):525-529 http://www.ijmedicine.com.

6. Missiriya, S. Knowledge and Practice of Postnatal Mothers Regarding Personal Hygiene and

Newborn Care. International Journal of Pharmaceutical Sciences, 2016; 40(1):89-93.

7. Al-Mutairi, Norah Faleh, Yousef Abdullah Al-Omran, and P. J. Parameaswari. "Breastfeeding

practice and knowledge among women attending primary health-care centers in Riyadh

2016." Journal of family medicine and primary care, 2017; 6.2 (2017): 392.

8. AL-Abedi, N. F. H., & Al-Asadi, K. M. N. Assessment of Mother's Knowledge toward

Breastfeeding at AL-Najaf City, International Journal of Scientific and Research

Publications, 2016; Volume 6, Issue 12.

9. Gupta, S., Sharma, M., Ekka, A., & Verma, N. Effect of health education on breastfeeding

initiation techniques among postnatal mothers admitted in a tertiary care center of Raipur city,

Chhattisgarh. International Journal of Community Medicine and Public Health, 2018; 5(10):

4340-4344.

10. Khodabandeh, F., Mirghafourv and, M., KamaliFard, M., Mohammad-Alizadeh-Charandabi,

S., & Asghari Jafarabadi, M. Effect of educational package on lifestyle of primiparous

mothers during postpartum period: a randomized controlled clinical trial. Health education

research, 2017; 32(5): 399-411.

11. Abd El-Razek, A. Enhancement of Mother's Self-Care Practices for Relieving Minor

Discomfort during Post-Partum Period. The Arab journal of the social sciences, 2013; 1 (13).

12. Berhea, T. A., Belachew, A. B., & Abreha, G. F. Knowledge and practice of Essential

Newborn Care among postnatal mothers in Mekelle City, North Ethiopia: A population-based

survey. Plos one, 2018; 13(8).

13. Shahid, R., & Mushtaq, M. (2009). Complications of grand multiparity. Pakistan Armed

Forces Medical Journal. 2009; 59(3):310-14.

14. Masoud, A. O., & Saber, N. Effectiveness of Puerperal Sepsis Self-Care Guideline on

Women's Health during Pureperuim, 2016.

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15

15. Indu, P. A Study to assess the knowledge and practice on selected aspects of postnatal care

among primi mothers in Aravindan Hospital, Coimbatore (Doctoral dissertation, PPG College

of Nursing, Coimbatore). 2016.

16. Abdulrazaq, A. G., Kabir, S., Mohammad, N. S., & Suleiman, I. H. The effect of educational

intervention on family planning knowledge, attitudes, and practices among married women in

a military barrack in northern Nigeria. African journal of reproductive health. 2014; 18(1):

93-101.

17. Shrestha, S., Adachi, K., Petrini, M. A., Shrestha, S., & Khagi, B. R. (2016). Development

and evaluation of a newborn care education program in primiparous mothers in Nepal.

Midwifery. 2016; 42, 21-28.

effectiveness of an educational program regarding the

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